National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 961339

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 961339
VAERS Form:2
Age:45.0
Sex:Female
Location:Georgia
Vaccinated:2021-01-18
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / UNK - / SYR

Administered by: Work      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Ambien
Current Illness:
Preexisting Conditions: COPD, Sleep apnea
Allergies: contrast die
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: possibly got it at clinic, possibly who administered shot. Pts. daughter said the pts boyfriend denied any symptoms the whole day but that in the middle of the night the pt passed away.


Changed on 5/7/2021

VAERS ID: 961339 Before After
VAERS Form:2
Age:45.0
Sex:Female
Location:Georgia
Vaccinated:2021-01-18
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / UNK - / SYR

Administered by: Work      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Ambien
Current Illness:
Preexisting Conditions: COPD, Sleep apnea
Allergies: contrast die die
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: possibly got it at clinic, possibly who administered shot. Pts. daughter said the pts boyfriend denied any symptoms the whole day but that in the middle of the night the pt passed away.


Changed on 5/14/2021

VAERS ID: 961339 Before After
VAERS Form:2
Age:45.0
Sex:Female
Location:Georgia
Vaccinated:2021-01-18
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / UNK - / SYR

Administered by: Work      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Ambien
Current Illness:
Preexisting Conditions: COPD, Sleep apnea
Allergies: contrast die die
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: possibly got it at clinic, possibly who administered shot. Pts. daughter said the pts boyfriend denied any symptoms the whole day but that in the middle of the night the pt passed away.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=961339&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166